Sexual Problems Treatments Delhi NCR
Executive Summary
Sexual dysfunction represents a significant global health concern, affecting a substantial portion of the population. Globally, up to 43% of women and 31% of men experience some form of sexual dysfunction, impacting their satisfaction and overall quality of life.1 Infertility, a key sexual health issue often intertwined with sexual dysfunction, affects approximately 1 in 6 people worldwide, with an estimated global prevalence of 17.5%.3 Global figures from 2021 indicated over 110 million women and 55 million men living with infertility, with prevalence rates projected to continue rising through 2040.4 Within India, male sexual disorders exhibit a broad prevalence ranging from 10% to 52%.5 Notably, the prevalence of Erectile Dysfunction (ED) among Type 2 Diabetes Mellitus patients in India is estimated to be as high as 60.57%, significantly higher than in non-diabetic individuals.6
Delhi NCR, as a major metropolitan hub, offers a rich and varied treatment landscape for sexual problems, encompassing both conventional allopathic medicine and traditional systems such as Unani and Ayurveda.7 The pervasive nature of sexual dysfunction and infertility, both globally and specifically in India, highlights a substantial public health burden. The wide array of treatment options available in Delhi NCR suggests a dynamic healthcare market that caters to diverse patient needs, cultural preferences, and potentially, a growing demand for traditional medicine alongside modern interventions. This indicates that effective public health strategies in the region must acknowledge and potentially integrate these varied approaches to provide comprehensive care.
Conventional medical treatments for sexual problems typically involve pharmacological interventions (e.g., PDE5 inhibitors for Erectile Dysfunction, SSRIs for Premature Ejaculation, hormone replacement for low libido), surgical procedures (e.g., penile implants, fallopian tube repair), and advanced assisted reproductive technologies (e.g., IVF, IUI).15 While often effective, these treatments can be associated with side effects, high costs, or invasiveness.28 The Unani system of medicine, founded on the principles of humoral balance, offers a holistic approach. Its treatment modalities for sexual health include herbal remedies (pharmacotherapy), regimental therapies (e.g., hydrotherapy, cupping), dietotherapy, and psychological support.31 Unani treatments are frequently highlighted for their natural basis and reported fewer side effects.7
The simultaneous presence and utilization of both conventional and Unani treatments in Delhi NCR, coupled with patient testimonials favoring the holistic and low-side-effect profile of traditional medicine, signal a growing patient preference for complementary and alternative approaches. This creates a significant opportunity for developing integrated care models that strategically combine the strengths of both systems. Such integration could lead to more comprehensive, patient-centric, and potentially more effective outcomes by addressing both the physiological and broader well-being aspects of sexual health. The effectiveness of conventional treatments, while valuable, can be limited by side effects or high costs. This unmet need often motivates patients to explore alternative therapies. Unani medicine, with its emphasis on natural remedies and claims of fewer side effects, directly addresses these concerns, positioning it as an attractive option for patients seeking gentler or more holistic approaches.
1. Introduction to Sexual Dysfunction
Sexual dysfunction is a prevalent and often distressing health concern that can significantly impact an individual's quality of life and relationships. Understanding its various forms, prevalence, and underlying causes is fundamental to developing effective treatment strategies.
Sexual dysfunction is broadly defined as any issue occurring during the sexual response cycle - which includes phases of excitement, plateau, orgasm, and resolution - that impedes an individual or couple from achieving sexual satisfaction.1 This broad definition encompasses a variety of specific conditions affecting both genders.
Male Sexual Dysfunction: The most commonly discussed male sexual dysfunctions include Erectile Dysfunction (ED), characterized by persistent difficulty in achieving or maintaining an erection adequate for satisfactory sexual performance.36 Premature Ejaculation (PE) is another prevalent issue, defined as reaching orgasm and ejaculating too quickly, often before or very soon after vaginal penetration, leading to distress for one or both partners.1 Other recognized male sexual problems include delayed or inhibited ejaculation (orgasm occurring too slowly or not at all) and low libido (a significant reduction in sexual interest or drive).1
Female Sexual Dysfunction: In women, sexual dysfunction manifests in various forms, including diminished sexual desire (low libido), impaired sexual arousal, difficulty or inability to achieve orgasm (anorgasmia), and sexual pain disorders. Examples of pain disorders include dyspareunia (painful intercourse) and inadequate vaginal lubrication, which can lead to discomfort during sexual activity.1 These issues can be generalized or specific to a particular partner or situation.1
The consistency in defining and classifying sexual dysfunctions across both conventional medical literature and Unani perspectives, such as Unani terms like Uqr for infertility, Zof-e-Bah for sexual debility, and Surʻat-e-Inzāl for PE 7, is noteworthy. This shared understanding of the clinical presentation, despite differing etiological frameworks, is fundamental for effective communication and potential collaborative care between practitioners of different medical systems. Regardless of their philosophical approach, healthcare providers can recognize and discuss the same patient problems. This congruence in clinical understanding is a crucial prerequisite for developing integrated care pathways, as it facilitates mutual understanding and referral between different medical disciplines.
Sexual dysfunction is a globally prevalent issue. Studies indicate that up to 43% of women and 31% of men are affected to varying extents.1 Infertility, a significant sexual health problem, has been experienced by approximately 1 in 6 people worldwide, with an estimated global prevalence of 17.5%.3 In 2021, an estimated 110,089,459 women and 55,000,818 men globally were living with infertility. The age-standardized prevalence rates for infertility increased by an average of 0.49% for males and 0.68% for females between 1990 and 2021, with projections indicating a continued rise through 2040.4
In the Indian context, male sexual disorders are reported to have a prevalence ranging from 10% to 52%.5 A specific study on Type 2 Diabetes Mellitus patients in India estimated the prevalence of Erectile Dysfunction (ED) to be as high as 60.57% 6, significantly higher than in non-diabetic individuals.6 The high and, in some cases, increasing prevalence of sexual dysfunction and infertility globally and within India underscores a substantial and growing public health challenge. The particularly high prevalence of ED among diabetic patients in India highlights a critical comorbidity that demands targeted and possibly integrated management strategies. This data collectively emphasizes the urgent need for accessible, effective, and diverse healthcare solutions to address these widespread conditions. The rising prevalence of infertility and the high rates of ED in diabetic patients point to specific demographic and comorbidity patterns. This suggests that healthcare systems must be prepared for a growing demand for sexual health services and should consider specialized approaches for high-risk groups. The data reinforces the argument for exploring and integrating various treatment modalities, including traditional systems like Unani, which often emphasize holistic health and lifestyle modifications relevant to managing chronic conditions like diabetes.
Sexual dysfunction is rarely caused by a single factor; instead, it typically arises from a complex interplay of physiological, psychological, and lifestyle elements.36
Physiological Causes: Vascular and metabolic conditions, such as heart disease, atherosclerosis (clogged blood vessels), hypertension (high blood pressure), and hyperlipidemia (high cholesterol), can significantly impair blood flow to the genitals, directly affecting arousal and erectile function.36 Diabetes is a particularly prominent risk factor, damaging the tiny filters and blood vessels in the kidneys and having a profound impact on sexual function.52 Obesity and metabolic syndrome also contribute to sexual dysfunction by affecting hormone levels and increasing the risk of cardiovascular diseases and type 2 diabetes.57
Hormonal imbalances, such as low testosterone in men and low estrogen in women, can lead to decreased sexual desire and impaired reproductive function.1 Polycystic Ovary Syndrome (PCOS), a common endocrine disorder, significantly impacts female fertility and ovulation.59 Other endocrine disorders involving the thyroid, pituitary, and adrenal glands can also contribute to hormonal imbalances affecting sexual health.50 Neurological disorders, including multiple sclerosis, Parkinson's disease, epilepsy, diabetic neuropathy, and injuries to the brain or spinal cord, can disrupt the neural pathways essential for sexual response, including erections and vaginal sensitivity.44
Structural and functional issues, such as Peyronie's disease (penile curvature), enlarged prostate (BPH), uterine fibroids, endometriosis, and damage or blockage of fallopian tubes, can interfere with sexual function or conception.59 Infections, particularly sexually transmitted infections (STIs) like chlamydia and gonorrhea, can cause long-term damage to reproductive organs, leading to infertility or chronic pain.59 Other reproductive tract infections can also negatively impact sperm production.63
Psychological Causes: Mental and emotional factors are frequently intertwined with sexual dysfunction. These include stress, anxiety (especially performance anxiety), depression, feelings of guilt or shame, low self-esteem, and relationship conflicts.1 Past sexual trauma, misinformation, and inadequate sex education can also predispose individuals to psychosexual problems.51
Lifestyle Factors: Certain lifestyle choices and environmental exposures are significant contributors. These include smoking, excessive alcohol consumption, illicit drug use, sedentary habits, strenuous physical labor, and exposure to environmental toxins (e.g., pesticides, industrial chemicals).59 Additionally, some prescription medications (e.g., certain antidepressants, blood pressure medications) can have sexual side effects.20
The extensive overlap of risk factors for sexual dysfunction with those for major chronic systemic diseases (e.g., diabetes, hypertension, obesity) highlights that sexual health is not an isolated domain but a critical indicator and component of overall systemic well-being. This profound interconnectedness suggests that holistic treatment approaches, such as those offered by Unani medicine, which inherently address lifestyle, diet, psychological state, and underlying humoral imbalances, may offer particularly effective and sustainable solutions by targeting the root causes of these multifactorial problems rather than just managing symptoms. This strong overlap indicates that sexual health is deeply integrated with general health and not merely a localized issue. A purely symptomatic or organ-specific approach may be insufficient for long-term resolution. Traditional holistic systems like Unani, which inherently aim to restore overall bodily balance (humors, temperament) and emphasize lifestyle and psychological well-being, are uniquely positioned to offer comprehensive care that can improve both sexual health and general systemic health simultaneously.
Table 1: Common Types of Sexual Dysfunction and Their Core Symptoms
|
Type of Dysfunction |
Affected Gender(s) |
Definition/Core Symptom |
Common Manifestations |
Associated Factors (Physiological, Psychological, Lifestyle) |
|
Erectile Dysfunction (ED) |
Male |
Difficulty getting or keeping an erection firm enough for sexual activity 36 |
Trouble getting/keeping an erection, reduced sexual desire 43 |
Vascular issues (heart disease, hypertension, diabetes, obesity, high cholesterol), neurological disorders, hormonal imbalances, penile trauma, certain medications, smoking, alcohol, illicit drugs, stress, anxiety, relationship problems 36 |
|
Premature Ejaculation (PE) |
Male |
Reaching orgasm and ejaculating too quickly 1 |
Ejaculation before or very soon after penetration, distress for partners 45 |
Performance anxiety, stress, temporary depression, low self-confidence, lack of communication, certain medications 18 |
|
Delayed/Inhibited Ejaculation |
Male |
Difficulty or inability to achieve orgasm or ejaculation, or experiencing it too slowly 1 |
Prolonged time to ejaculation, absence of ejaculation |
Physical factors, illness, medications 1 |
|
Low Libido (Reduced Interest in Sex) |
Male & Female |
Lack or absence of sexual drive/interest 1 |
Decreased desire for sexual activity, general or towards partner 1 |
Low testosterone (men), low estrogen (women), depression, anxiety, fatigue, relationship problems, certain medications, alcohol, illicit drugs, stress, systemic illness 1 |
|
Female Arousal Disorder |
Female |
Difficulty achieving or maintaining sufficient sexual arousal 1 |
Lack of vaginal lubrication/dilation, decreased genital/nipple sensation, aversion to sexual contact 1 |
Lack of stimulation, hormonal changes (pregnancy, breastfeeding, menopause), anxiety disorders 1 |
|
Female Orgasmic Disorder (Anorgasmia) |
Female |
Orgasm absent, markedly diminished in intensity, or significantly delayed 1 |
Difficulty achieving climax despite adequate stimulation 1 |
Physical factors, illness, certain medications (e.g., SSRIs), psychological issues, relationship problems 1 |
|
Sexual Pain Disorder (Dyspareunia) |
Female (mainly) |
Pain experienced during sexual activities 1 |
Inadequate vaginal lubrication, underlying conditions (endometriosis, fibroids), infections 1 |
Inadequate lubrication, hormonal changes, infections, endometriosis, uterine fibroids, pelvic floor dysfunction, psychological factors 1 |
|
Infertility |
Male & Female |
Inability to conceive after 1 year of unprotected, frequent sex 77 |
Unsuccessful attempts at conception, psychological distress 8 |
Ovulatory dysfunction (PCOS), fallopian tube damage/blockage, uterine issues (fibroids, endometriosis), low sperm count/quality, hormonal imbalances, genetic factors, lifestyle (obesity, smoking, alcohol, stress), environmental toxins 79 |
2. Conventional Medical Treatments for Sexual Problems
Modern medicine offers a range of interventions for sexual dysfunctions, typically categorized into pharmacological, surgical, and therapeutic/lifestyle approaches. These treatments often provide targeted solutions based on specific physiological or psychological diagnoses.
Erectile Dysfunction (ED): The primary pharmacological approach for ED involves oral medications such as Sildenafil (Viagra), Tadalafil (Cialis), Vardenafil, and Avanafil (Stendra). These drugs, known as Phosphodiesterase-5 (PDE5) inhibitors, work by relaxing the smooth muscles in the penis, thereby facilitating increased blood flow and promoting erection.17 For men with diagnosed low testosterone levels (hypogonadism), testosterone replacement therapy may be prescribed, often as an adjunctive treatment alongside PDE5 inhibitors to improve overall sexual function.17
Premature Ejaculation (PE): While no specific FDA-approved drugs for PE exist in the U.S., Selective Serotonin Reuptake Inhibitors (SSRIs) are commonly used off-label due to their known side effect of delaying orgasm. Examples include Paroxetine (Paxil), Escitalopram (Lexapro), Citalopram (Celexa), Sertraline (Zoloft), and Fluoxetine (Prozac).18 Other medications like Tramadol (a pain reliever) and PDE5 inhibitors can also be prescribed, sometimes in combination with SSRIs for enhanced effect.18 Topical anesthetic creams or sprays containing agents like benzocaine, lidocaine, or prilocaine are applied directly to the penis to reduce sensitivity and delay ejaculation.18
Female Low Libido (Hypoactive Sexual Desire Disorder): Treatment strategies often begin with sex education and counseling to address psychological factors. For premenopausal women diagnosed with hypoactive sexual desire disorder, FDA-approved non-hormonal medications like Flibanserin (Addyi) and Bremelanotide (Vyleesi) are available.20 For menopausal women experiencing vaginal dryness and discomfort that impacts desire, hormone therapy, including vaginal estrogen creams or suppositories, can improve lubrication and comfort.20 Off-label use of testosterone may also be considered in some cases.20 Additionally, if antidepressants are contributing to low libido, healthcare providers may recommend switching to medications with fewer sexual side effects, such as Mirtazapine or Bupropion.20
Female Orgasmic Disorder (Anorgasmia): Treatment primarily focuses on lifestyle modifications, various forms of therapy, and addressing any underlying medical conditions. While specific pharmacological agents for anorgasmia are not strongly evidence-based, hormone replacement therapies (estrogen, and sometimes testosterone) may offer some benefit, particularly if related to menopausal symptoms.22 Similar to low libido, if SSRIs are implicated, alternative antidepressants or dose adjustments may be explored.23
Dyspareunia (Painful Intercourse): Pharmacological interventions for dyspareunia depend on the identified cause. These can include over-the-counter lubricants for vaginal dryness, antibiotics, antivirals, or antifungals for infections, hormone therapy (e.g., topical estrogen, Ospemifene for menopause-related dryness), and antidepressants to manage nerve pain or psychological components.24
The frequent reliance on off-label use of medications, such as SSRIs for PE, and the acknowledged presence of side effects across various pharmacological interventions, highlight a significant limitation in conventional sexual health treatment. These factors can lead to patient dissatisfaction, non-adherence, or a reluctance to pursue conventional treatment. This unmet need in conventional medicine directly fuels the demand for alternative therapies. Unani medicine's emphasis on natural remedies and its claim of fewer side effects directly addresses these limitations, positioning it as an attractive option for patients seeking gentler or more holistic approaches.
Male Sexual Dysfunction: For severe cases of Erectile Dysfunction that do not respond to less invasive treatments, surgical options include penile implants. These devices are surgically placed into the penis, allowing for controlled erections.17 Non-surgical medical devices like vacuum erection devices (penis pumps) are also utilized; these plastic tubes fitted over the penis create a vacuum to draw blood, inducing an erection.17
Female Sexual Dysfunction/Infertility: Surgical interventions play a crucial role in addressing anatomical issues contributing to sexual dysfunction or infertility. Procedures can include repairing blocked or scarred fallopian tubes, removing uterine fibroids (benign growths that can interfere with implantation), or treating endometriosis (tissue growth outside the uterus).15 In cases of Polycystic Ovary Syndrome (PCOS) where ovulation-inducing medications are ineffective, a minor surgical procedure called laparoscopic ovarian drilling may be performed.15
Assisted Reproductive Technologies (ART): For couples struggling with infertility, ARTs offer significant pathways to conception. In Vitro Fertilization (IVF) involves fertilizing eggs with sperm in a laboratory setting, with the resulting embryo then transferred to the uterus.8 Intrauterine Insemination (IUI), also known as artificial insemination, involves placing specially prepared sperm directly into the uterus to increase the chances of fertilization.15 In situations where gametes are compromised, donor eggs or sperm can also be utilized.15
Surgical procedures and advanced ARTs represent highly invasive, often costly, and sometimes last-resort options in conventional medicine. The significant financial burden associated with procedures like IVF 28 can be a major barrier for many couples in Delhi NCR. This economic and physical burden further amplifies the appeal of less invasive, potentially more affordable traditional treatments like Unani, which can serve as a primary or complementary option for those seeking alternatives to surgery or high-cost ARTs. These barriers can lead patients to seek alternative, less burdensome treatments. Unani medicine is often presented as a more affordable and natural alternative, directly addressing these concerns and broadening the spectrum of accessible care options for patients in Delhi NCR.
Counseling and Sex Therapy: These interventions are recognized as fundamental for addressing the psychological underpinnings of sexual dysfunction. They are crucial for managing issues such as stress, anxiety (including performance anxiety), depression, feelings of guilt, relationship problems, and performance anxiety.19 Sex therapists, licensed professionals with specialized training in human sexuality, utilize psychotherapy (talk therapy) to help individuals and couples improve communication, understand sexual needs, and modify unhelpful thoughts and behaviors related to sex.70
Behavioral Techniques: Specific behavioral strategies are employed for certain dysfunctions. For Premature Ejaculation, techniques like "start and stop" or "squeeze therapy" teach individuals to gain better control over ejaculation by modulating arousal levels.18 For female orgasmic disorders, directed masturbation and sensate focus programs help individuals and couples explore and understand their sexual responses.22
Lifestyle Modifications: Modern medicine strongly advocates for lifestyle changes as a cornerstone of sexual health management. Key recommendations include maintaining a healthy weight (as both obesity and being underweight can inhibit ovulation and affect sperm quality), engaging in regular, moderate exercise (avoiding overly strenuous activity which can inhibit ovulation), implementing stress management techniques (such as yoga and meditation), ensuring adequate sleep, and strictly avoiding smoking, excessive alcohol consumption, and illicit drug use.59 Preventing sexually transmitted infections (STIs) through safe sexual practices is also crucial.59
The significant emphasis placed on lifestyle modifications and psychological therapies within conventional medicine's treatment protocols reveals a profound convergence with the holistic principles of Unani medicine. This alignment suggests a shared understanding that sexual health is intrinsically linked to overall well-being, extending beyond mere physiological function. This convergence creates a fertile ground for synergistic integrated care models, where both systems can reinforce each other's strengths, leading to more comprehensive and sustainable patient outcomes by addressing the interconnected physical, mental, and lifestyle factors. This philosophical alignment makes integrated care not just feasible but potentially highly effective, as interventions from both systems can complement and enhance each other's effects, providing a more comprehensive approach to patient well-being.
3. The Unani System of Medicine for Sexual Health in Delhi NCR
The Unani system of medicine, a traditional healing system with a rich history, offers a distinct approach to sexual health by focusing on holistic balance and individualized care.
Unani medicine, also known as Unani Tibb or Greco-Arabic medicine, is a traditional healing system with historical roots in ancient Greek philosophy, notably Hippocrates, and further developed by scholars in the Muslim world.82 Its fundamental premise is that disease is a natural process, and the physician's role is to support the body's innate healing capabilities.
The core of Unani philosophy revolves around the concept of the four bodily humors (Akhlat): blood (Dam), phlegm (Balgham), yellow bile (Safra), and black bile (Sauda).82 Health is maintained when these humors are in a state of equilibrium, and imbalances are believed to be the root cause of disease. The system also incorporates the concept of Mizaj (temperament), which classifies individuals, diets, and drugs into four primary qualitative types: Hot & Dry, Hot & Wet, Cold & Wet, and Cold & Dry.82 Treatment in Unani medicine aims to reverse pathological shifts in a person's temperament by prescribing drugs or diets with opposing temperaments.82
Unani medicine identifies seven basic physiological principles (al-umoor al-tabiyah) that constitute the totality of a human being and are essential for health maintenance: elements (arkan), temperament (mizaj), humors (akhlat), organs (aaza), vital spirit (arwah), faculties (quwa), and functions (afaal).82 Disease is understood as a disruption in the balance of these components.82 Furthermore, Unani emphasizes Tabiyat (the body's inherent self-preservation and healing power) and Asbab-e-Sittah-Zarooriah (six essential external factors: air, food and drinks, movement and rest, mental work and rest, sleep and wakefulness, and retention and excretion), which are crucial for maintaining a synchronized biological rhythm and overall balanced existence.83
The highly intricate and holistic framework of Unani medicine, particularly its humoral theory and the concept of Mizaj, offers a unique diagnostic and therapeutic lens that extends beyond mere symptomatic relief. This suggests that Unani treatments for sexual problems are not merely targeting localized reproductive issues but aim to address systemic imbalances within the individual's entire physiological and psychological constitution. This comprehensive approach potentially leads to more sustainable and far-reaching health improvements, distinguishing it from more reductionist medical paradigms. The Unani system seeks to restore overall body balance and address root causes, not just surface symptoms. This means that a Unani treatment for a sexual problem is inherently a treatment for the whole person, potentially leading to broader health benefits beyond the primary complaint. Such a holistic approach may appeal to patients seeking deeper, more enduring solutions and could foster greater overall well-being and vitality, aligning with a patient-centered model of care.
In Unani medicine, sexual problems are fundamentally understood as manifestations of imbalances within the body's humoral system, often attributed to factors like excessive coldness and dryness. These imbalances are believed to affect vital energies (nafs - soul, quwwat - physical strength, and mizaaj - temperament), leading to impaired physiological functions, including blood flow to reproductive organs.38
Male Sexual Dysfunction:
● Erectile Dysfunction (Isterkha e Ala-e-Qazeeb): Unani literature describes ED as a "weakness of the penis" (Isterkha e Ala-e-Qazeeb) or Nuqs-e-Nauoz. It is attributed to a paralysis or weakness (Isterq'a) of the penile nerves and muscles, which prevents proper dilation and erection. General body weakness (Zaufe Badan) is also considered a contributing factor.30 Furthermore, ED is classified as a disorder of the Mizaj-e-Ma'asal (temperament of the seminal fluid), stemming from an imbalance of the four humors.38
● Premature Ejaculation (Surʻat-e-Inzāl): This is defined as ejaculation occurring immediately after insertion or even during foreplay.41 It can be linked to Zof-e-Bah (sexual debility).42 From a Unani perspective, PE is seen as a humoral imbalance, with psychological factors such as stress, anxiety, and performance pressure also playing a significant role in exacerbating symptoms.41
● Low Libido: Reduced sexual desire is often associated with low testosterone levels, but Unani also considers psychological factors like depression, anxiety, fatigue, and relationship difficulties as contributing causes.36
● Oligospermia (Qillat-e-Mani): This refers to a deficiency in the quantity of semen or spermatozoa. Unani physicians recognize this as a significant cause of male infertility, responsible for up to 90% of cases, and also address other defects in spermatozoa.49
Female Sexual Dysfunction/Infertility (Uqr):
● Infertility (Uqr or banjhpan) is defined in Unani as the inability of a woman to conceive after one year of regular unprotected intercourse.7 Its causes are diverse and include congenital defects of the uterus and ovaries, obesity (furbahi), abnormal uterine temperament (su'i mizaj-e-Rahem), faulty production of semen (ovum) (fasad e mani), and complications from other general diseases.7
● Polycystic Ovary Syndrome (PCOS), a leading cause of anovulation-induced infertility, is explained in Unani literature under conditions related to liver problems, phlegmatic illness, obesity, and amenorrhea. The primary Unani concept for PCOS is the predominance of khilt-e-balgham (phlegm) in the body.60
Unani medicine's detailed etiological framework for sexual dysfunctions, which links specific conditions to underlying humoral imbalances and organ weaknesses (e.g., Zof-e-Bah being dependent on the brain, heart, liver, and testes) 45, enables a highly individualized diagnostic and treatment approach. This contrasts with more generalized modern diagnostic categories, particularly for "idiopathic" conditions. This personalized medicine approach, inherent in Unani, could be particularly beneficial for complex or unexplained cases where conventional medicine struggles to identify a clear cause or provide a tailored solution. The detailed etiology allows Unani practitioners to develop highly individualized treatment plans based on a patient's unique Mizaj (temperament) and specific imbalances. Modern medicine sometimes categorizes conditions as "idiopathic" when a clear cause isn't found, leading to empirical treatment. Unani's personalized approach offers a potential alternative or complementary strategy for patients with complex or unexplained sexual problems, as it seeks to address the unique underlying constitutional factors rather than just the presenting symptoms.
Unani treatments for sexual health are multifaceted, aiming to restore humoral balance and strengthen vital faculties through a combination of pharmacotherapy, regimental therapy, dietotherapy, and psychological support.31
Herbal Remedies (Pharmacotherapy) for Male and Female Sexual Dysfunctions and Infertility:
A wide array of herbs is utilized for their aphrodisiac and vitality-enhancing properties. These include Safed Musli (Chlorophytum borivilianum), Ashwagandha (Withania somnifera), Gokshura (Tribulus terrestris), Shilajit, Saffron (Crocus sativus), Nutmeg (Myristica fragrans), Kapikachhu (Mucuna pruriens), and Bala (Sida cordifolia). These herbs are believed to enhance libido, improve sperm quality and count, increase stamina, and reduce stress, contributing to overall reproductive well-being.31
For Erectile Dysfunction (ED), polyherbal oral formulations (Majoon/Electuary) and topical liniments (Tila) have shown comparable efficacy to conventional treatments like Tentex Forte and Himcolin in clinical studies.93 Specific Unani formulations like Dawa-ul-Khasak are also used.30 For Premature Ejaculation (PE), Unani formulations such as Majoon-e-Piyaz, Habbe Mumsik Tilai (containing saffron, amber, and musk), Habbe Amber Momyaee (with amber and musk), Majun Salab (from orchis mascula and saffron), and Kushta Qalai (purified calx of tin) are employed to fortify the reproductive system, enhance stamina, and delay ejaculation.41 Topical oils like Roghan Suranjan are also applied.41
In the context of female infertility, Unani drugs and formulations aim to induce ovulation (Muwallid-i-Manī), act as uterine tonics (Muqawwī-i-Raḥim), and aid conception (Mu'īn-i-Ḥaml).7 Specific examples include Majun mocharas, nuskha Mu'īn-i-Ḥaml, Habbe Hamal, Majune Moine Hamal Ambari, Dawa-ul-Misk Motadil, and Majune Suparipak.7 Widely used herbs like Ashwagandha, Shatavari, Shilajit, and Triphala are also integral to female fertility treatments.8
Regimental Therapies (Ilaj-Bit-Tadbeer): Hydrotherapy, Massage, Cupping, and other physical interventions.
These non-pharmacological procedures are designed to detoxify the body, eliminate waste materials, purify the blood, improve circulation, and strengthen the body's defense mechanisms.32
● Hydrotherapy (Abzan, Sitz bath): Involves immersing the hips and buttocks in plain or medicated water (e.g., decoctions of mazu, juft baloot) for therapeutic effects, including relief from uterine pain, leucorrhea, and vulvitis.8
● Massage (Dalak): Involves systematic manipulation of body tissues to disperse morbid matter, alter the temperament of organs, and enhance blood circulation.96
● Cupping (Hijamah): A method where suction is created on the skin using cups to promote healing, draw out stagnant blood and toxins, and improve localized blood flow.95
● Diuresis (Idrar-e-baul): Aims to excrete poisonous matters, waste products, and excess humors through urine, thereby purifying the blood and addressing renal disorders.96
● Enema (Huqna): Used for the removal of waste materials from the intestine and to relieve pain in the kidneys and bladder.96
● Other therapies: The extensive range of regimental therapies also includes Riyazat (exercise), Takmeed (fomentation), Nutool (pouring medicated lukewarm water on affected parts), Zimaad wa Tila (application of ointments and liniments), Tareeq (inducing sweating), Ishaal (purgation), Qai (emesis), Imala (diversion of morbid material), Fasd (venesection), and Kai (cauterization).95
Dietotherapy (Ilaj Bil-Ghiza): Nutritional guidance for sexual
health.
Unani practitioners emphasize the crucial role of diet in maintaining and restoring sexual health, recommending specific dietary changes and foods with aphrodisiac properties.37 For infertility, dietary recommendations include increased consumption of dairy proteins (milk, lassi, paneer), soaked almonds and walnuts, sweet juicy fruits (e.g., mangoes, peaches), and spices like ajwain, cumin, turmeric, and black cumin.9 Conversely, avoiding high-fat and preserved foods is advised.9
The detailed pharmacopeia of Unani herbal remedies and the diverse range of regimental therapies offer a broad spectrum of non-invasive or minimally invasive treatment options. This suggests that Unani medicine can provide personalized, multi-modal interventions that may circumvent some of the side effects or invasiveness associated with conventional treatments, making it a valuable complementary approach, especially for chronic conditions. This multi-modal approach means a tailored treatment plan can be developed, potentially avoiding the "one-size-fits-all" pharmacological approach of conventional medicine or its more invasive procedures. The emphasis on natural ingredients and non-invasive methods could lead to better patient adherence and satisfaction, especially for those wary of synthetic drugs or surgery.
Delhi NCR hosts numerous Unani clinics and practitioners specializing in sexual health and infertility, offering a wide array of services.7
Dr. Aslam Javed: A particularly prominent Unani Sexologist Doctor for male and female sexual health in Delhi NCR, Dr. Aslam Javed is the founder of Unani Herbal clinic, established in 2005.9 He holds a BUMS degree from Ayurvedic & Unani Tibbia College, Delhi University (1989), and has extensive clinical experience, including at Safdarjang Hospital and Hindu Rao Hospital in Delhi.104 He is noted for his personalized herbal formulations, emphasis on natural balance, lifestyle and dietary guidance, and a focus on addressing root causes of sexual dysfunction.104 Dr. Javed has received various honors for his contributions to the Unani system of medicine, including the "Best Unani (Herbal) Physician" award in 1998 and the "VERSATILE PERSONALITY AWARD" in 1999.105 He also claims to offer a permanent cure for kidney stones using a combination of powders, pills, and oils.110
The presence of highly-rated, experienced Unani practitioners like Dr. Aslam Javed, with decades of practice and recognition, indicates a well-established and trusted traditional healthcare infrastructure in Delhi NCR. The longevity of these clinics and the positive patient testimonials suggest a degree of patient satisfaction and perceived efficacy that contributes to the continued demand for Unani treatments. This strong local presence and reputation mean Unani medicine is not merely an "alternative" but a significant, accessible, and preferred healthcare option for many in Delhi NCR, especially for sensitive issues like sexual health.
Unani treatments for infertility have demonstrated positive outcomes in reported cases. For instance, a 25-year-old nulligravida with unexplained infertility successfully conceived after just two menstrual cycles of Unani treatment involving nuskha Mu'īn-i-Ḥaml and Ma'jūn mocharas, leading to an uneventful pregnancy and healthy delivery.8 Another case study reported conception within two months for female infertility, notably without any reported side effects.7 A pilot study focusing on infertility due to cervical factors showed that 7 out of 12 patients (58.33%) conceived with Unani treatment.115
For Erectile Dysfunction, studies suggest that Unani herbal remedies, including ingredients like ashwagandha, shilajit, and saffron, have a reported success rate ranging from 70% to 80%, with one study indicating an 85% success rate.38 Furthermore, a clinical trial found that polyherbal Unani formulations (Majoon and Tila) were equally effective as conventional drugs (Tentex Forte and Himcolin) in managing ED.93
Patient testimonials across various Unani clinics in Delhi NCR frequently highlight "good" or "excellent" service, describing treatments as "effective" and "simple," often leading to "speedy recovery" and "positive vibes" from the practitioners.98 Patients often praise Unani doctors for being "friendly," "humble," "compassionate," and for dedicating ample time to explain health issues thoroughly.112 A recurring emphasis in patient feedback and Unani promotional materials is the natural approach and reported absence of side effects, which is a significant differentiator from some conventional treatments.7
While reported success rates and patient testimonials are encouraging, the available information also highlights the need for more rigorous, large-scale, and randomized controlled trials to scientifically validate the efficacy of Unani treatments, particularly when compared to conventional medicine. The emphasis on "no side effects" in Unani marketing points to a key differentiator that resonates strongly with patients, suggesting that patient preference is heavily influenced by perceived safety and the holistic nature of the care. This indicates a disparity between anecdotal or case study evidence and the level of evidence typically required in modern medical research. To fully integrate Unani into mainstream healthcare or gain wider acceptance, more rigorous scientific validation is necessary. However, the strong patient testimonials and focus on safety are powerful drivers of patient choice, indicating that perceived well-being and natural approaches are highly valued.
Table 2: Key Unani Herbs and Formulations for Sexual Health and Infertility
|
Herb/Formulation Name (Unani/Botanical) |
Primary Use |
Key Properties/Actions |
Relevant Snippet IDs |
|
Ashwagandha (Withania somnifera) |
Male/Female Sexual Dysfunction, Infertility, Low Libido |
Adaptogenic, stress-reducing, hormone-balancing, improves sperm quality/count, enhances vitality, ovulation-inducing 31 |
31 |
|
Shatavari (Asparagus racemosus) |
Female Infertility, Low Libido |
Rejuvenating, supports hormonal balance, nourishes reproductive organs, boosts ovulation, improves egg quality, strengthens uterine lining, increases libido 31 |
31 |
|
Shilajit |
Male/Female Sexual Dysfunction, Infertility, Low Libido |
Mineral-rich, enhances overall vitality, improves sperm quality/motility/count, reduces fatigue, increases stamina 31 |
31 |
|
Gokshura (Tribulus terrestris) |
Male/Female Sexual Dysfunction, Infertility, Low Libido |
Enhances libido, strengthens reproductive tissues, improves sperm count/quality, enhances ovarian health 85 |
85 |
|
Kapikachhu (Mucuna pruriens) |
Male/Female Sexual Dysfunction, Infertility |
Balances hormones, increases sperm count/quality, reduces stress 85 |
85 |
|
Saffron (Crocus sativus) |
Male Sexual Dysfunction (PE), Infertility |
Aphrodisiac, fortifies reproductive system, enhances sexual stamina, ovulation-inducing 7 |
7 |
|
Nutmeg (Myristica fragrans) |
Male Sexual Dysfunction, Low Libido |
Aphrodisiac, nervous stimulant, increases libido and potency 90 |
90 |
|
Majun mocharas |
Female Infertility |
Uterotonic, ovulation-inducing, aids conception 8 |
9_1_1, 8 |
|
nuskha Mu'īn-i-Ḥaml |
Female Infertility |
Uterotonic, ovulation-inducing, aiding in conception 8 |
8 |
|
Habbe Hamal |
Female Infertility |
Uterine tonic, ovulation-inducing, aids conception 7 |
7 |
|
Majoon-e-Piyaz |
Male Premature Ejaculation |
Potent Unani formulation for PE 94 |
94 |
|
Habbe Mumsik Tilai |
Male Premature Ejaculation |
Fortifies reproductive system, enhances sexual stamina 41 |
41 |
|
Majun Salab |
Male Premature Ejaculation |
Enhances sexual vitality and performance, aids in delaying ejaculation 41 |
41 |
|
Kushta Qalai |
Male Premature Ejaculation |
Nerve-strengthening properties, enhances sexual function 41 |
41 |
4. Comparative Analysis and Integrated Care
The landscape of sexual problem treatment in Delhi NCR is characterized by the co-existence of conventional modern medicine and the traditional Unani system. A comparative analysis reveals distinct strengths and limitations for each, highlighting the potential for synergistic integrated care models.
Conventional Medicine:
● Strengths: Modern medicine offers evidence-based efficacy for many sexual dysfunctions, providing rapid symptomatic relief (e.g., PDE5 inhibitors for ED).17 It boasts advanced diagnostic techniques for precise identification of underlying causes and offers sophisticated surgical and assisted reproductive technology (ART) options for severe cases, such as IVF for infertility or penile implants for refractory ED.8
● Limitations: A primary limitation lies in the potential for significant side effects from pharmacological treatments, as seen with SSRIs for PE or hormonal therapies.18 The high cost of ART procedures, such as IVF, can also pose a substantial barrier to accessibility for many patients.28 Furthermore, conventional approaches can sometimes be less holistic, potentially focusing on isolated symptoms rather than fully addressing the complex interplay of psychological and lifestyle factors as primary interventions.8
Unani System of Medicine:
● Strengths: Unani medicine adopts a holistic approach, aiming to address the root causes of sexual problems and promote overall well-being by restoring humoral balance and strengthening vital faculties.31 Its emphasis on natural remedies is often associated with reported fewer side effects, which is a significant appeal to patients.7 Treatment is highly personalized, based on the individual's unique temperament and humoral profile. Moreover, Unani treatments can be more affordable compared to high-tech ARTs.64 The system also integrally addresses stress and anxiety, recognizing their profound impact on sexual health.8
● Limitations: A notable limitation is the general lack of robust scientific evidence from large-scale randomized controlled trials to definitively support the efficacy of many Unani formulations and therapies in a Western medical paradigm.115 There can also be inconsistencies due to a perceived lack of standardization and quality control in practice and manufacturing.32 Additionally, access to pure Unani clinics may be limited to certain areas, such as Old Delhi.104
The comparative analysis reveals that both systems have distinct advantages and disadvantages, creating a compelling argument for integrated care. Conventional medicine excels in acute, diagnostically clear cases with immediate interventions, while Unani offers a sustained, holistic approach for chronic conditions and overall well-being. The "lack of robust scientific evidence" for Unani, while a limitation in Western medical paradigms, is often offset by patient satisfaction with its holistic, low-side-effect profile, indicating a need for research methodologies that can capture these broader benefits. The strengths of one system often address the limitations of the other, suggesting inherent complementarity. This implies that combining them could lead to better overall patient outcomes. The "evidence gap" for Unani does not diminish its patient appeal, highlighting that patient-centered outcomes (holistic well-being, perceived safety) are valued alongside purely clinical efficacy. This calls for a re-evaluation of how "evidence" is defined and generated for traditional medicine.
Unani medicine is increasingly positioned as a valuable complementary therapy that can be used alongside conventional treatments for infertility and other sexual problems.8 This approach acknowledges that Unani interventions can potentially enhance the effectiveness of conventional treatments by addressing underlying imbalances, promoting overall reproductive health, and mitigating the side effects associated with conventional medications.8 Some clinics in Delhi NCR already practice integrated health care, combining modern medicine with traditional Ayurvedic or Unani approaches.87
The frequent mention of "complementary therapy" indicates a growing recognition within both traditional and modern medical communities that Unani can play a supportive role in patient care. This points towards an emerging trend of integrative medicine in Delhi NCR, where patients can benefit from a combined approach. This implies that traditional systems are not necessarily seen as replacements for modern medicine but as valuable additions. This suggests a shift towards integrative healthcare models, where different systems work together. This is a positive development for patient care, allowing for a broader range of therapeutic options and potentially better outcomes by combining strengths.
For optimal patient outcomes in an integrative setting, collaborative care and open communication between healthcare providers are paramount. Qualified Unani practitioners can work in conjunction with patients' conventional healthcare providers to develop comprehensive, tailored treatment plans that leverage the strengths of both systems.8
Open communication between specialists (e.g., nephrologists, gynecologists, urologists) and Unani practitioners is essential to ensure coordinated care, avoid potential contraindications, and prevent adverse interactions between different therapies.116 Patients are also advised to actively participate in their care by consulting qualified practitioners, maintaining realistic expectations regarding treatment outcomes, and diligently monitoring their progress through regular follow-ups.31
The recurring emphasis on collaboration and open communication highlights a critical need for inter-system dialogue and mutual respect to ensure patient safety and optimal outcomes in an integrative setting. This suggests that the success of integrated care models hinges not just on the availability of diverse treatments but on the effective coordination and mutual understanding among practitioners from different medical philosophies. The importance of consultation, collaboration, and communication between different types of practitioners is emphasized to ensure safety, prevent interactions, and tailor treatment. This implies that effective integrated care is not just about what treatments are offered but how they are managed and coordinated. This points to a need for formal guidelines or training for practitioners in integrated care settings to foster better inter-system understanding and patient management.
Table 3: Comparative Overview of Conventional and Unani Treatment Modalities
|
Aspect |
Conventional Medicine Characteristics |
Unani Medicine Characteristics |
Relevant Snippet IDs |
|
Philosophy |
Symptom-focused, disease-specific, often reductionist. Targets specific physiological mechanisms. |
Holistic, patient-centered, emphasizes humoral balance and individual temperament (Mizaj). Aims to address root causes and overall well-being. |
82 |
|
Diagnostic Approach |
Laboratory tests (blood, urine), imaging (ultrasound, MRI), physical examination, specialized tests (e.g., semen analysis, hormonal assays). |
Examination of pulse (Nabdh), urine (Baul), stool (Baraz), and assessment of Mizaj (temperament). Considers physical, mental, emotional well-being. |
83 |
|
Treatment Modalities |
Pharmacological (oral medications, injections), surgical procedures (implants, repairs), Assisted Reproductive Technologies (IVF, IUI), counseling, behavioral therapy, lifestyle modifications. |
Herbal remedies (pharmacotherapy), regimental therapies (hydrotherapy, massage, cupping, purgation, enema), dietotherapy, psychological support. |
31 |
|
Primary Focus |
Symptomatic relief, disease eradication, structural correction, technological intervention. |
Restoring natural balance (humors, temperament), strengthening innate healing powers, detoxification, overall vitality. |
31 |
|
Reported Side Effects |
Can have significant side effects (e.g., from hormonal medications, SSRIs). |
Generally reported to have fewer side effects due to natural ingredients. |
104_1_2, 7 |
|
Cost |
Can be very high, especially for ARTs (e.g., IVF). |
Often presented as more affordable, particularly compared to high-tech ARTs. |
9_1_2, 28 |
|
Evidence Base |
Primarily supported by rigorous, large-scale randomized controlled trials. |
Primarily supported by classical texts, clinical experience, case studies, and some smaller-scale studies; often noted for lack of robust scientific evidence by Western standards. |
115 |
5. Recommendations
Addressing sexual problems and infertility in Delhi NCR effectively requires a multi-pronged approach that considers the diverse needs of individuals and the strengths of various medical systems.
5.1. For Individuals Seeking Treatment: Navigating options, informed decision-making, and seeking qualified care.
Individuals experiencing sexual health concerns are encouraged to seek professional assistance, as these issues are common and often treatable.1 It is advisable to consult a primary care provider or OB-GYN initially to understand the nature of the problem and rule out any underlying physical causes.16
If considering Unani medicine, it is important to consult a qualified and experienced Unani practitioner who specializes in infertility or sexual health.31 A discussion of potential underlying causes with the Unani practitioner is crucial to tailor a treatment approach based on Unani principles and the individual's unique constitution.63 Patients should approach their treatment journey with realistic expectations, understanding that individual results may vary, and improvements may take time.31
A combined approach, where Unani medicine is used as a complementary therapy alongside conventional treatments, is often beneficial. Maintaining open communication between all healthcare providers involved in one's care is essential to ensure coordinated treatment, prevent contraindications, and avoid drug interactions.8
Furthermore, adopting healthy lifestyle choices is paramount. This includes maintaining a balanced diet, engaging in regular, moderate exercise, practicing stress management techniques (such as yoga and meditation), ensuring adequate sleep, and strictly avoiding smoking, excessive alcohol consumption, and illicit drugs.59 The emphasis on patient agency, informed choice, and integrated lifestyle changes reflects a shift towards patient-centered care. This implies that effective treatment for sexual problems in Delhi NCR is not just about medical intervention but also about empowering individuals to make holistic health choices and actively participate in their care. A successful healthcare journey for sexual problems requires active patient involvement and a holistic approach to their well-being, not just passive receipt of medical treatments. This highlights the importance of patient education and accessible information about diverse treatment options, as well as the need for healthcare providers to be equipped to discuss and integrate these options.
5.2. For Healthcare Providers and Policy Makers: Fostering integrative approaches, promoting research, and ensuring standardization.
Foster Integrative Approaches: Healthcare providers and policy makers should actively encourage collaboration between conventional and Unani practitioners. This will facilitate the provision of comprehensive and patient-centric care, leveraging the distinct strengths of both systems to achieve optimal outcomes.116
Promote Research and Validation: Investment in rigorous scientific studies, particularly large-scale randomized controlled trials, is crucial to further validate the efficacy and safety of Unani formulations and therapies for sexual dysfunction and infertility.115 This will help bridge the existing evidence gap, enhance the credibility of Unani medicine, and facilitate its wider acceptance and integration into mainstream healthcare.
Ensure Standardization and Quality Control: Addressing the current lack of standardization and quality control in certain aspects of Unani medicine is vital to ensure consistency and reliability of treatments.32 This may involve developing clear guidelines for practice, manufacturing processes, and quality assurance of Unani products.
Enhance Education and Training: Supporting educational initiatives for both conventional and Unani practitioners is essential to foster mutual understanding, improve inter-system communication, and facilitate the seamless implementation of integrated care models. This could include cross-training programs or joint conferences.
Address Affordability and Accessibility: Continued efforts are needed to make fertility treatments, encompassing both conventional and traditional approaches, more affordable and accessible to a wider population in Delhi NCR, as cost remains a significant barrier for many couples.28
Public Health Awareness: Developing comprehensive public health campaigns is important to raise awareness about the multifactorial causes of sexual dysfunction and infertility. These campaigns should promote early detection, encourage healthy lifestyles, and inform the public about the full spectrum of available treatment options across all recognized systems of medicine.
The recommendations for policy makers and healthcare providers collectively point towards a strategic imperative to formalize and support integrative medicine within the public health framework of Delhi NCR. This is not merely about offering choices but about creating a regulated, evidence-informed, and patient-safe environment where diverse medical systems can co-exist and complement each other, ultimately improving population health outcomes for sexual problems. The existence of gaps in scientific evidence for Unani and the recognized need for better integration call for active government and institutional support for research, standardization, and inter-system collaboration. Formalizing integrative medicine can lead to a more efficient and effective healthcare system that addresses patient needs comprehensively. This is a step towards a more pluralistic and patient-centric healthcare model, acknowledging the cultural and historical significance of traditional medicine while ensuring modern standards of safety and efficacy.
6. Conclusion
Sexual problems and infertility represent complex, widespread health challenges in Delhi NCR, influenced by a myriad of interconnected physiological, psychological, and lifestyle factors. The comprehensive analysis reveals that both conventional modern medicine and the traditional Unani system offer distinct yet often complementary approaches to treatment. While conventional methods provide targeted interventions, rapid symptomatic relief, and advanced technologies, Unani medicine emphasizes a holistic, personalized approach with natural remedies, regimental therapies, and lifestyle modifications, often with reported fewer side effects.
The growing interest in traditional therapies and positive patient experiences highlight the value and perceived efficacy of Unani medicine within the local healthcare landscape. Moving forward, an integrated care model, characterized by collaborative practice between conventional and Unani practitioners, robust scientific validation of traditional therapies, and enhanced patient-practitioner communication, holds immense promise for providing comprehensive, effective, and patient-centered solutions for sexual health in Delhi NCR. This approach respects diverse medical philosophies while striving for optimal health outcomes for the population.
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Researched and written by: Museb Rafeeq founder of Wind Song Enterprises
.
The HOO-IMM PLUS (A, B, C, D, E) is an absolutely new, novel, pioneering and revolutionary concept from Unani Herbal to medical science. It is a very safe, efficacious Indian medicine for the relief of AIDS according to the degree & stage of affliction.
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